Predictors of incidence of fall in elderly women; a six-month cohort study

Objective: To determine the incidence and predictive factors of the falls in elderly women in Northern Iran

Methods: A total of 717 elderly women aged 60 years and above in Amirkola, Northern of Iran participated in this study. Age, history of falls during the 12 months leading to the study, accompanying diseases, status of balance, cognitive status, orthostatic hypotension, state of depressive symptoms, strength of quadriceps muscles and serum vitamin D level were assessed as independent variables during baseline measurement. Incidence of fall [dependent variable] was recorded during a six-month follow-up period

Results: Of the participants, 7.8% had experience of fall, out of which 50.0% experienced it once, 25.0% twice, and the rest three times or more. With aging, the incidence of orthostatic hypotension also increased and symptomatic depression became aggravated. In the final model, the variables of the number of accompanying diseases [RR=1.78, 95% CI: 1.00-3.18], severe cognitive impairment [RR=12.70, 95% CI: 3.05-52.86], and depressive symptoms [RR=3.19, 95% CI: 1.48-6.86] remained as strong associated variables for incidence of fall

Conclusion: With increasing severity of depressive symptoms and cognitive impairment along with the comorbidities, incidence of fall also increases in the elderly. Thus, psychological aspects of the elderly and comorbidities in this group should be taken care of seriously

The effect of metal artifacts on the identification of vertical root fractures using different fields of view in cone-beam computed tomography

PURPOSE: The aim of this study was to investigate the effects of metal artifacts on the accurate diagnosis of root fractures using cone-beam computed tomography (CBCT) images with large and small/limited fields of view (FOVs). MATERIALS AND METHODS: Forty extracted molar and premolar teeth were collected. Access canals were made in all teeth using a rotary system. In half of the teeth, fractures were created by the application of mild pressure with a hammer. The teeth were then randomly put into a wax rim on an acryl base designed in the shape of a mandible. CBCT scans were obtained using a Newtom 5G system with FOVs of 18 cmx16 cm and 6 cmx6 cm. A metal pin was then placed into each tooth, and CBCT imaging was again performed using the same fields of view. All scans were evaluated by two oral and maxillofacial radiologists. The specificity, sensitivity, positive predictive value, negative predictive value, and likelihood ratios (positive and negative) were calculated. RESULTS: The maximum levels of sensitivity and specificity (100% and 100%, respectively) were observed in smallvolume CBCT scans of teeth without pins. The highest negative predictive value was found in the small-volume group without pins, whereas the positive predictive value was 100% in all groups except the large-volume group with pins. CONCLUSION: The specificity of CBCT decreased with the presence of a pin in the large-volume group, but not in the small-volume group.

Root-crown ratio in permanent dentition using panoramic radiography in a selected Iranian population

Statement of the Problem: Determining the crown-root ratio is crucial in many dental clinical decisions. There are no reliable data presented for Iranian population

Purpose: The aim of this study was to assess the root-crown ratio of permanent teeth with regards to the relationship of gender and jaw type using panoramic radiographs. The reliability of method was also assessed

Materials and Method: The crown and root lengths of teeth were measured by a digital caliper on panoramic radiographs of 185 individuals except for the third molars. A total of 1994 teeth was studied and 50.8% of the teeth belonged to males and 49.2% belonged to females. The modified Lind method was applied

Results: The highest mean root-crown ratios in both arches of both genders were obtained in the second premolars, followed by the first premolars and canines. In both genders, the lowest root-crown ratios were found in the maxillary central incisors. In male patients, the mean root-crown ratio was higher [p= 0.003] than that of females. Using Bland-Altman analysis, a non-significant difference of 0.006 [95% CI: -0.012-0.024] and 0.0002 [95% CI: -0.011-0.011] were found for intra-observer and inter-observer agreement, respectively

Conclusion: Assessment of the root-crown ratio in permanent dentition could be performed on panoramic radiographs with acceptable reproducibility in an Iranian Population. Considering observed differences, our findings suggest that for the accurate assessment, this ratio must be calculated for male and female patients and also for the upper and lower jaws, separately

Can the follicle-crown ratio of the impacted third molars be a reliable indicator of pathologic problem?

Statement of the Problem: The presence of impacted third molars in the jaws is a common finding in the routine dental examination of patients. Concerning the odontogenic components of the dental follicle, it can be the origin of different types of odontogenic cysts and tumors

Purpose: The aim of this study was to find feasible radiographic criteria to help differentiate between normal and pathological dental follicles

Materials and Method: 134 asymptomatic impacted third molars were recruited in this study. Then, based on the radiographic measurements, the ratio between the diameter of the dental follicle and the mesiodistal width of the tooth crown was calculated. After surgical removal of impacted third molars, the related dental follicles were evaluated histopathologically. Statistical analyses were performed by adopting chi-square test, t-test, receiver oprating characteristic [ROC] curve, and logistic regression using SPSS-19 software

Results: The mean ratio of the dental follicle's diameter to the mesiodistal width, in the normal and cystic follicle group was 1.18 +/- 0.07 and 1.18 +/- 0.08, respectively. There was no statistically significant difference between this ratio and the histopathological evaluation. Based on the logistic regression analysis, only the age >20 years and inflammation had predictive value in identifying cystic changes in dental follicle

Conclusion: According to the findings of the current study, the ratio of dental follicle diameter to the mesiodistal width of the teeth cannot not be employed as a diagnostic index to differentiate between normal and pathological dental follicle

Effect of metformin and flutamide on anthropometric indices and laboratory tests in obese/overweight PCOS women under hypocaloric diet

This study was designed to investigate the effect of metformin and flutamide alone or in combination with anthropometric indices and laboratory tests of obese/overweight PCOS women under hypocaloric diet. This single blind clinical trial was performed on 120 PCOS women. At the beginning, hypocaloric diet was recommended for the patients. After one month while they were on the diet, the patients were randomly divided in 4 groups; metformin [500 mg, 3/day], flutamide [250 mg, 2/day], combined, metformin [500 mg, 3/day] with flutamide [250 mg, 2/day] and finally placebo group. The patients were treated for 6 months. Anthropometric indices and laboratory tests [fasting and glucose-stimulated insulin levels, lipid profile and androgens] were measured. A one-way ANOVA [Post Hoc] and paired t-test were performed to analyze data. A p

Helicobacter Pylori infection and metabolic parameters: is there an association in elderly population?

The association between Helicobacter pylori [HP], as one of the most prevalent infections, and serum glucose level was inconsistent with previous studies. Moreover, there are contradictory reports about the relationship between HP infection and lipid profile. The purpose of this study was to determine the relationship between HP infection with glycemic and lipid profiles in elderly people. This cross-sectional study was conducted on 1,300 subjects over 60 years in Amirkola Health and Ageing Project. After using a standard questionnaire, the venous sampling was done to determine FBS, triglyceride [TG], cholesterol, low density lipoprotein [LDL], high-density lipoprotein [HDL] and IgG anti-HP after a 12-h overnight fast. The information about the individuals was analyzed using SPSS-17. The P < 0.05 was considered statistically significant. The prevalence of HP infection in diabetic and nondiabetic subjects was 77.5% and 75.7%, respectively, which had no statistically significant difference. Also, there was no significant difference between the serum lipid level including TG, LDL and HDL cholesterol with levels of anti-HP antibodies. The rate of HP infection in patients with hypertension was 75% and 78.3% in healthy patients, in which the difference was not statistically significant. In terms of body mass index [BMI], the prevalence of infection in the group with normal BMI was 77.3% and for the overweight and obese elderly population, it was 74.7%, and 77.5%, respectively [P = 0.445]. The findings revealed that in a large population of elderly in the northern part of Iran, HP infection is not associated with BMI, serum glucose and lipid profile as well as blood pressure

[Anti Streptococcus mutans non fluoride and fluoride containing sealants after adding nano-silver particles]

Since recurrent caries are one of the major causes of failure in resin restorations, the production of antibacterial resin composites was always under investigation. The aim of this study was to evaluate the efficacy of fissure sealants containing nanosilver particles against the Streptococcus mutans. In this experimental study, the antibacterial properties of two sealants [with fluoride [Clinpro 3M] and without fluoride [Concise 3M] was investigated with 0, 0.01, 0.02, 0.03, 0.04, 0.05% w/w after adding nano-silver using direct contact test. Sealants formed on the walls of 500ml micro tube and after curing, they left in contact with bacterial suspension. In periods of 3, 24, 48h, a 10 microl volume of liquid medium was placed in blood agar culture and after 24 h incubation at 37°C, the number of S.mutans colony was counted by colony counter. Data were analyzed using ANOVA and T-test. Results reported sealants with fluoride comparing to non fluoride ones had significant effect on inhibition of S.mutans growth [P<0.001]. The direct contact test demonstrated that by increasing the amount of nano particles, the bacterial growth was significantly diminished [P<0.001]. While sealants with fluoride demonstrated antibacterial effect, sealants with incorporation of higher weight percentage of nanosilver particles, had stronger and more significant antibacterial effect in direct contact test

Effect of tissue adhesive Octyl-2-Cyanoacrylate in traumatic facial wounds

Tissue adhesives have been taken into consideration because they do not need to be removed after wound healing. This study was conducted to compare scars remained by Octyl-2-Cyanoacrylate and sutures in traumatic facial wounds in adults. This randomized clinical trial study was performed on 50 patients aged 15-50 years referred to Babol Shahid Beheshti Hospital due to traumatic facial wounds. Written informed consent was obtained for each patient. The patients were divided into two groups. In the first group, patients were treated with 5-0 nylon suture and Octyl-2-Cyanoacrylate was used for wound repairment in second group. The patients were followed up on 1, 7, 60 and 120 days after wound healing and assessed by Patient and Observer Scar Assessment Scale [POSAS] and Vancouver criteria to evaluate remaining scar. Also amount of pain intensity was determined by the Visual Analogue Scale [VAS] criteria, 7 days after wound healing. Data was analyzed by SPSS V16, t-test, Friedman, Chi-square and Man-Whitney-U tests. Twenty-eight [56%] were male and 22[44%] female. There was a significant decreasing trend in Vancouver and POSAS indices during 120 days of study [p<0.001]. Based on POSAS and Vancouver criteria there was no significant difference between two groups on the days 1, 60 and 120. However, on day 7, there was significantly better healing result in the adhesive group compared to the suture group. Based on the VAS criteria; the average pain intensity was 4.14 +/- 1.16 in sutured group, on 7th day [p=0.00]. There was no significant difference in wound closure time between the two groups [p=0.07]. Generally, there was no significant difference between the scar left by sutures and tissue adhesives after 120 days

Evaluation of panoramic radiography at showing width of the dental follicle

Considering probable incidence of pathological changes in the follicles of impacted teeth, this study is conducted to evaluate pericoronal radiolucency of impacted third molars. In this cross-sectional study, widths of follicular spaces of 201 impacted third molars were measured on panoramic radiographs. Under local anesthesia, the teeth along with the dental follicles were surgically removed. After routine procedure, they histopathological were examined. After evaluating 201 dental follicles it was observed that, 50.7% of cases [102 cases] showed pathological changes and all of them were dentigerous cysts. Incidence of cystic changes in the follicles of third molars of patients aged 21 years and above, is 1.465 times more than patients who were under 21 years old. Also in dental follicles of lower third molars, the incidence of pathological changes was 1.957 times more than maxilla. Cystic changes in the evaluation of follicular widths up to 1.5 mm, was observed in 48% of cases, up to 2 mm, in 73.5% of cases, up to 2.5 mm, in 87.2% of cases and up to 3 mm, in 92.1% of cases. It seems that occurrence of cystic changes in dental follicles increases with increase in age and width of follicular space. However, considering the high incidence of cystic changes in pericoronal radiolucency around the impacted third molars, this study supports the prophylactic removal of impacted third molars

A comparative study of cone-beam computed tomography and digital periapical radiography in detecting mandibular molars root perforations

PURPOSE: The aim of this in vitro study was to determine the sensitivity and specificity of cone-beam computed tomography (CBCT) and digital periapical radiography in the detection of mesial root perforations of mandibular molars. MATERIALS AND METHODS: In this in vitro study, 48 mandibular molars were divided into 4 groups. First, the mesial canals of all the 48 teeth were endodontically prepared. In 2 groups (24 teeth each), the roots were axially perforated in the mesiolingual canal 1-3 mm below the furcation region, penetrating the root surface ("root perforation"). Then, in one of these 2 groups, the mesial canals were filled with gutta-percha and AH26 sealer. Mesial canals in one of the other 2 groups without perforation (control groups) were filled with the same materials. The CBCT and periapical radiographs with 3 different angulations were evaluated by 2 oral and maxillofacial radiologists. The specificity and sensitivity of the two methods were calculated, and P<0.05 was considered significant. RESULTS: The sensitivity and specificity of CBCT scans in the detection of obturated root canal perforations were 79% and 96%, respectively, and in the case of three-angled periapical radiographs, they were 92% and 100%, respectively. In non-obturated root canals, the sensitivity and specificity of CBCT scans in perforation detection were 92% and 100%, respectively, and for three-angled periapical radiographs, they were 50% and 96%, respectively. CONCLUSION: For perforation detection in filled-root canals, periapical radiography with three different horizontal angulations would be trustworthy, but it is recommended that CBCT be used for perforation detection before obturating root canals.

Assessment of vertical root fracture using cone-beam computed tomography

PURPOSE: The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in the diagnosis of vertical root fractures in a tooth with gutta-percha and prefabricated posts. MATERIALS AND METHODS: This study selected 96 extracted molar and premolar teeth of the mandible. These teeth were divided into six groups as follows: Groups A, B, and C consisted of teeth with vertical root fractures, and groups D, E, and F had teeth without vertical root fractures; groups A and D had teeth with gutta-percha and prefabricated posts; groups B and E had teeth with gutta-percha but without prefabricated posts, and groups C and F had teeth without gutta-percha or prefabricated posts. Then, the CBCT scans were obtained and examined by three oral and maxillofacial radiologists in order to determine the presence of vertical root fractures. The data were analyzed using IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA). RESULTS: The kappa coefficient was 0.875+/-0.049. Groups A and D showed a sensitivity of 81% and a specificity of 100%; groups E and B, a sensitivity of 94% and a specificity of 100%; and groups C and F, a sensitivity of 88% and a specificity of 100%. CONCLUSION: The CBCT scans revealed a high accuracy in the diagnosis of vertical root fractures; the accuracy did not decrease in the presence of gutta-percha. The presence of prefabricated posts also had little effect on the accuracy of the system, which was, of course, not statistically significant.

[In vitro evaluation of different liners in microleakage of class II posterior composite restorations]

Packable composites with high viscosity might not adapt properly to internal surfaces and cervical areas. The aim of this study was to assess the microleakage of class II posterior composite restorations performed using different methods. Ninety proximal cavities were prepared in extracted sound premolar teeth, divided into three groups and filled as follows: 1- packable composite [3M filtek P60], 2-Hybrid composite [Z250] + P60 composite and 3- Resin-modified glass ionomer liner + P60 composite. Afterwards, the samples were immersed in 0.5% Foushin solution and sectioned. Gingival microleakage was then graded. Obtained data were analyzed using paired t-test and analysis of variance. In regard to distal cavities, significant difference was seen between the groups 1 and 3 [P=0.01] as well as groups 2 and 3 [P=0.03]. Comparing microleakage of mesial and distal cavities, there was a significant difference in groups 1 [P=0.003] and 2 [P=0.005]. Based on the findings of this study, application of Z250 composite had no effect on reduction of microleakage of class II posterior composite restorations. Vitremer liner decreased microleakage in dento-gingival margins.

[Efficacy of domperidone and pyridostigmine in the treatment of patients with functional dyspepsia: a randomized clinical trial]

The majority of dyspeptic patients do not have identifiable disease, which is also known as functional dyspepsia. The therapeutic approach to patients with functional dyspepsia is still a matter of debate; prokinetic agents are commonly used for symptom relief. This study aims to evaluate the efficacy of domperidone and pyridostigmine [an inhibitor of cholinesterase] in patients with functional dyspepsia. This was a single-blind, randomized clinical trial performed on 117 patients [December 2007 to November 2009] diagnosed with functional dyspepsia according to ROME II criteria. The effects of 4 weeks of treatment with domperidone [10 mg tid], yridostigmine [60 mg tid], and placebo were compared. We scored each patient according to VAS to rank the severity of 8 different upper GI symptoms [epigastric fullness, early satiety, gnawing, nausea, vomiting, belching, bloating, and epigastric pain] both before and at the end of treatment. Data were entered into SPSS software version 16 and analyzed. P<0.05 was considered significant. At the end of treatment, the total dyspeptic symptom score decreased from 24 to 13. According to ANOVA, there were significant differences between the 3 groups in 3 out of 8 symptom scores of bloating [p=0.039], early satiety [p=0.006], and nausea [p=0.016]. The post hoc test determined that domperidone was more effective than pyridostigmine and placebo in improvement of early satiety [p=0.038 and p=0.014, respectively]. Domperidone was more effective than pyridostigmine in the control of nausea [p=0.024]. Domperidone [p=0.023] and pyridostigmine [p=0.042] were superior in relieving bloating symptoms compared to placebo. Overall, in the control of GI symptoms domperidone was more effective than placebo [p=0.045]. domperidone and pyridostigmine are useful in improving bloating, early satiety, and nausea. However they are similar to placebo in controlling epigastric pain, fullness, belching and gnawing

p63 expression in randomized odontogenic cysts

To find out the immunohistochemical assessment of p63 expression in odontogenic cysts based on the differences among their clinical behaviors. This study was carried out on 34 archival paraffin-embedded specimens of odontogenic cysts. We obtained the specimens from the Pathology Department of Babol University of Medical Sciences, Babol, Iran from March 2003 to February 2008. The specimens comprised 12 dentigerous cysts, 9 radicular cysts, and 13 keratocystic odontogenic tumors [KCOTs]. The immunohistochemical technique was performed using the Envision system for evaluation of p63 expression. The KCOT revealed the highest p63 expression and the differences between the 3 groups was statistically significant. P63 expression might be helpful when identifying cyst types with more aggressive and invasive phenotype

Efficacy of hepatitis B vaccine in those who lost hepatitis B surface antigen during follow-up

The level of HBsAg in some chronic hepatitis B virus [HBV]-infected individuals may decline over time so that it is not detectable in serum. To assess the efficacy of HBV vaccine in those who lost their HBsAg without seroconverssion to anti-HBs antibody. From April 1993 to December 2008, of 1603 chronic HBV-infected individuals, 34 [22 men and 12 women] became HBsAg-negative in follow-up visits, with no detectable anti-HBs antibody and HBV DNA in their sera. They received HBV vaccination at 0, 1 and 6 months [case group]. Fifty-two subjects [30 men and 22 women] who were negative for HBsAg, anti-HBs and anti-HBc antibody, received HBV vaccination according to the said schedule [control group]. Anti-HBs antibody was assessed one month after the last dose of vaccination in the both groups. The mean +/- SD age of the case and control groups was 38 +/- 12.7 and 33.4 +/- 8.6 years, respectively [p=0.07]. The sex distribution between these two groups were similar [p=0.652]. The mean +/- SD years of follow-up for the case group was 7.6 +/- 4.5 years. Anti-HBs antibody level >/= 10 IU/L was found in 8 [24%] subjects in the case group and in 45 [87%] in the control group [p<0.001]. The mean +/- SD anti-HBs antibody level in the case group was 68 +/- 32.66 and in the control group 344.6 +/- 38.9 IU/L [p<0.001]. We found that nearly 24% of chronic HBsAg-positive subjects who lost their HBsAg responded to HBV and the remaining cases need to be followed for occult HBV infection

Serum beta human chorionic gonadotropin levels at 16 days following embryo transfer in intra cytoplasmic sperm injection cycles to predict pregnancy outcome

To determine the prognostic value of beta human chorionic gonadotropin [beta-hCG] concentration on the sixteenth day after embryo transfer to predict pregnancy outcome. In this retrospective cohort study, beta-hCG levels were measured in 97 pregnant women that underwent intra-cytoplasmic sperm injection [ICSI] in Fatemeh-Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran from January 2008 to December 2009. Type, duration, causes of infertility, and age of patients, beta-hCG levels on the sixteenth day after embryo transfer, the number of embryos, and pregnancy outcome were assessed. Incidence of viable pregnancies in beta-hCG levels <100 IU/L [n=18] was 38.9%, and in beta-hCG levels >/= 100 IU/L [n=79] was 84.4%. Correlation of beta-hCG with pregnancy outcome was significant [p<0.001] Cut-off value of E-hCG to predict viable pregnancy was 100 IU/L [sensitivity - 91%, specificity - 48%, PPV - 85%, and NPV - 61%]. The beta-hCG levels >/= 200 IU/L with a sensitivity of 88%, specificity of 45%, PPV - 37%, and NPV = 91% had predicted twin pregnancy. Serum beta-hCG level on the sixteenth day after embryo transfer can be useful to predict the pregnancy outcome in ICSI cycles